Are People With Eczema at Greater Risk of Heart Disease?

In observance of American Heart Month, we connected with Dr. Anna Ascott, with the London School of Hygiene & Tropical Medicine, about the potential link between heart disease and atopic dermatitis (AD).  As recently as 2018, emerging research in the British Medical Journal demonstrated that people with severe AD had a 40% increased risk of heart attack and atrial fibrillation; 70% greater risk of heart failure; and 20% higher risk of stroke.  

In further exploration of this subject, Dr. Ascott and her fellow researchers reviewed 19 different studies on eczema and cardiovascular risks. With this meta-analysis, Ascott and fellow researchers found that risks of cardiovascular disease and certain cardiovascular events increased depending on the seriousness of a person’s eczema symptoms. Their results were published in The Journal of Allergy and Clinical Immunology. Specifically, the scientists found that severe eczema was associated with increased risk of angina (chest pain caused by inadequate blood to the heart), heart failure, myocardial infarction (heart attack) and cardiovascular-related death.

Inflammation and other possible cardiovascular risks associated with eczema

“In our research,” said Ascott, “we found that people with severe atopic eczema were more likely to develop cardiovascular diseases than people with milder forms of atopic eczema. This was also true for people who had atopic eczema that was active more regularly compared to those who only had active atopic eczema some of the time.” Ascott speculated that the reasons for this may be that a person with more severe and active eczema has more inflammation in the body and that increased inflammation increases the chances of developing cardiovascular problems, as is seen with other other inflammatory conditions, like rheumatoid arthritis. 

If this sounds like a lot to process, don’t worry. “The good news,” said Ascott, “is that although people with moderate and severe atopic eczema are at higher risk of heart disease, the overall risk is low. When we combined existing studies together, we found that the risk of developing angina, heart attack, heart failure, stroke or cardiovascular death was 15% greater in people with moderate atopic eczema and 32% greater in people with severe atopic eczema, compared to people with mild atopic eczema.”

Possible causes of increased heart health risks

There is not yet data to tell us exactly why or how severe eczema is associated with cardiovascular risks, but there are some theories. As Ascott mentioned, other inflammatory conditions have been linked to cardiovascular disease; people with eczema typically have weaker skin barriers which can lead to more skin infections and, in turn, greater overall inflammation. Another theory is that platelet dysfunction and differences in fibrin and clotting in patients with eczema could be a factor. Ascott noted, too, that certain treatments for eczema could impact cardiovascular risks. 

“Oral corticosteroids,” she said, “in short courses can be very helpful for patients. But if oral corticosteroids are used long term they have many side effects including increasing blood pressure and cholesterol, and increasing the risk of diabetes and obesity, all of which lead to cardiovascular diseases.” 

Given these links between severe eczema and cardiovascular conditions, should we be taking better care of eczema for heart-health reasons? Based on the limited research so far, Ascott is not yet sure. 

“This is a really important question,” she said. “Some studies in other diseases have looked at what happens if inflammation is reduced with treatments and have found that the likelihood of developing cardiovascular diseases does reduce, but we need to do more research on this topic with atopic eczema.”

Of course, when it comes down to it, everyone should be looking after their hearts as well as their skin. According to the CDC, heart disease is the leading cause of death for men, women and people of most racial and ethnic groups in the United States. 

For American Heart Month, we’ve got heart-healthy tips for people with eczema:

1. Most important: talk to your doctor about your heart health. If you have severe eczema, eczema that covers a large portion of your body, if your eczema is difficult to manage, or if your eczema flares for extended periods of time, ask your doctor about your heart health and whether there are any additional health risks you should consider.

2. Have your blood pressure checked regularly. This is likely already a part of your check-ups, but if not, or if you aren’t having check-ups, now’s the time to get into a routine. If push comes to shove, you can measure your blood pressure at certain pharmacies, as long as you follow up with a doctor about any concerning results. The U.S. Department of Health and Human Services says we should all be getting our blood pressure measured “regularly” after the age of 18. People at higher risk are recommended to have blood pressure taken once a year. What’s considered higher risk? You’re at increased risk for high blood pressure if you:

• Are overweight or obese;
• Are Black;
• Don’t get enough physical activity;
• Drink too much alcohol;
• Smoke;
• Don’t eat a healthy diet;
• Have kidney failure, diabetes or heart disease.

3. Monitor your cholesterol. Some pharmacies can also do cholesterol lab work. Again, please be sure to consult with a healthcare provider about your results. The CDC says that most healthy adults should have their cholesterol measured every four to six years. But if you have severe eczema, you probably want to consider having it reviewed more often. Children and adolescents should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.

4. Follow heart-healthy guidelines from the National Heart, Lung and Blood Institute:

• Know your family’s medical history and communicate it to your care providers. Pay special attention to any heart issues or diabetes mentioned by relatives.
• Eat well, focusing on foods that are low in: saturated fat, added sugar and salt. Eat more high-fiber foods (whole grains, fruits and vegetables) and better fats (like those in olive oil and fish). You can follow this nutritional and dietary advice for eczema and heart health.
• If at all, drink alcohol only in moderation. This means no more than one drink per day for women and two drinks or fewer per day for men. Avoiding alcohol may also help your eczema with studies showing drinking can make skin conditions worse. 
• Get active with at least 150 minus of moderate-intensity physical activity per week for adults (that’s just 21 minutes a day). Do something that increases your heart rate and is enjoyable. Walk, bike, dance, swim, skip, etc. 
• Stay at a healthy body weight. Easier said than done. We know. But by losing even 5% to 10% of your body weight (if you need to) you can help your heart. Talk to your doctor about what’s a heart-healthy weight for you. 
• Quit smoking and avoid secondhand smoke. If you need help kicking the habit, ask your doctor for advice or visit the CDC’s pages on this topic. There are medications, apps, and government resources to give you support. Other people in your life still smoke? Ask them to step outside. 
• Manage stress. This is great for your heart as well as your skin as we know that stress relief techniques help eczema and dealing with stress can help you to avoid eczema flares.
• Get enough sleep, ideally 7-9 hours per night for adults aged 18 or older. Having issues? Here’s why people with eczema have trouble sleeping (and what to do about it).

5. Be aware of the warning signs of heart conditions and get immediate medical help when you need it. Symptoms of a heart attack or another cardiovascular problem can include:

• Chest pain especially if it spreads to your arm or jaw and doesn’t pass quickly;
• Unexplained nausea, indigestion, or heartburn (particularly in women);
• Unusual fatigue or general weakness;
• Shortness of breath;
• Changes in skin color (gray pallor for light skin tones, more yellowish changes for those with brown skin, or pale palms or interior cheeks for those with dark skin);
• Coughing or wheezing that doesn’t go away or coughing up mucus that is pink or bloody;
• Swelling or numbness in the lower legs;
• Irregular heart beat;
• Feeling lightheaded or dizzy;
• Sweating for no reason;
• Unusual snoring (sleep apnea).
  

Not everyone is cognizant — not yet at least! — that there’s a connection between severe eczema and heart health, but now you are. We hope you use this information to advocate for yourself, your loved ones and heart health this month and every month. 
As always, we ❤ you.